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Quotes from Focus Groups of African Americans and Hispanic/Latinos with Diabetes

WellPoint conducted market research through in-depth interviews and focus groups (2007-2008)

• African American (n=44), Hispanic (n=37), and white (n=10)

Commercially insured adults living with diabetes separated by– Commercially insured adults living with diabetes, separated by gender

• Conducted by an independent market research firm

– R/E/L concordance between Interviewers and Participants

•Today, there are various resources for training health care professionals on “cultural competence” and cross-cultural communication skills.

•However, there are little to no resources that provide similar training to help patients, the medical consumer.

•The Health Equity, Cultural and Linguistics Program Office at WellPoint recognized this need to help educate medical consumersneed to help educate medical consumers.

• Created an online “Train the Trainer” course for health educators to prepare them to teach medical consumerism skills in face-to-face settings to patients.

1. User focus group conducted at Vision y Compromise Promoters Conference, 2009

• About 20 promoters, including lay CHWs and physicians

• Discussed their community observations and needs for training

• Identified learning objectives for the course

• Patient empowerment

• Preparation for health care visits

• Effective communication with health care professionals

• Patient navigation of the U.S. health care system

• Various care settings

• U.S. concepts of health, wellness and medicine

• Patient’s rights

• Health education program offerings (incl. from health plans such as DM)

2. Course content developed through

• Literature searches

• Review of clinical cross-cultural communication training materialsReview of clinical cross cultural communication training materials

3. Course review by external subject matter experts

• The Disparities Solution Center, Massachusetts General Hospital

• Department of Health Care Policy, Harvard Medical School

• Division of General Medicine, University of Miami 4

•Launched in Spring 2011 at BridgingHealthCareGaps.com

•New public service online training program – No cost

•Addresses health disparities and patient empowerment

•For CHWs and health educators

•Major topics

• Patient empowerment

• Preparation for health care visits

• Effective communication with health care professionals

• Patient navigation of the U.S. health care system

• Various care settings

• U.S. concepts of health, wellness and medicine

• Patient’s rights

• Health education program offerings (incl. from health plans such as DM)

• In addition to the online training content, the full curriculum is available for d l d d i tidownload and printing.

• “Teaching Tools For You” provides links to a lesson plan and worksheets

• Health educators can use these to help teach their patients.

• Each tool in the “Teaching Tools For You” section is explained during the course.

• Learners can download and print any or all of the documents for their use

•The curriculum uses story telling and sample dialogs that compare and contrast “effective” and “less effective” consumer communications with a physicians

• Models key medical consumerism skills.

•The online course content is replicated into downloadable handouts that health educators can print out to distribute to patients.

The course includes discussion on culture-related topics that impact doctor-patient communications.

For example, here is a screenshot about respect.

This was built in response to our research that indicated that some cultures may think it is disrespectful to ask the doctor any questions or to bring up personal problems suchis disrespectful to ask the doctor any questions or to bring up personal problems such as not being able to afford prescribed medicines or screenings.

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The course also offers tips on how to improve communication skills to help patients get the most from their visit with the doctor.

For example, patients who use open-ended questions with their doctor may get more information than if they asked “yes/no” types of questions (close-ended questions)

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There are a number of handouts that can be downloaded and printed.

For example, here is the Appointment Preparation Worksheet, to help patients prepare for successful health care provider visits.

• The Worksheet prompts patients to write down important information in a short, simple manner that the health care provider can easily understand.

The patients would complete this worksheet before going to the doctor (while in• The patients would complete this worksheet before going to the doctor (while in the unrushed comfort of their own homes) to help them think about and communicate their health concerns

The second module of the course is an overview of how to navigate the U.S. health care system. Includes:

• Tips on Accessing the U.S. Health Care System

• Types of physicians and places patients can go to for health care

• A brief discussion of health insurance coverage

• How to find out more information about diseases, treatments and ways to stay healthyhealthy.

Understanding Patient’s Rights is Another Key Component of Medical Consumerism

From our focus groups, we heard that CHWs and promoters wanted help about how to explain patient rights.

In response, we created this component of the course.

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A new study by researchers at UCSF and the Kaiser Permanente Division of Research found that:.P ti t h t di th i di b t ith d t i th i l h• Patients who cannot discuss their diabetes with a doctor in their own language may have poorer health outcomes, even when interpreter services are available,

• Links language barriers with worse diabetes-related health outcomes. It examined only Spanish speakers.

• The study found that, among Latino diabetes patients with limited English skills, those seen by non-Spanish speaking doctors were nearly twice as likely to have poor control of their blood sugar than those whose doctors spoke Spanish.

Findings shared in the January 2011 issue of the Journal of General Internal MedicineFindings shared in the January 2011 issue of the Journal of General Internal Medicine.

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[Additional details]

“Diabetes is a complex disease that requires a high level of patient understanding and engagement for successful management,” said Alicia Fernandez, MD, a UCSF professor of medicine and lead author of th t d “Th ti t d di t i ti ith S i h ki h i i tthe study. “These patients may need direct communication with Spanish-speaking physicians to manage their disease appropriately.”

“The study adds to evidence that the conversation between physician and patient is of critical importance to the success of diabetes care,” said senior author Andrew Karter, PhD, principal investigator of the DISTANCE Study and research scientist at the Kaiser Permanente Division of Research.

While this study does not definitively prove that language barriers cause the disparity in diabetes control, it suggests the importance of direct communication with a doctor who speaks the patient’s language theit suggests the importance of direct communication with a doctor who speaks the patient s language, the authors said. They recommended that health plans offer diabetes patients a health care provider who speaks the patient’s language whenever possible.

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